Running After Knee Mosaicplasty, OATS, and Meniscectomy

  One of my favorite quotes has always been "Only those who will risk going too far can possibly find out how far one can go." (TS Elliot.) In that spirit, I'm not going to settle for just a successful return to ultramarathoning (see previous post), I want to see how close to my "old self" I can get and maybe even do something I've never done before. I'm still very far from normal after the right knee cartilage surgeries I had in 2020 and 2021. Even this far out from the surgery, I think there is room for improvement. I don't have full range of motion and there is still much stiffness and a little bit of pain to deal with. If I were to completely focus on doing what is best for knee function, I would imitate what has been done so successfully for athletes returning to team sports that require speed, strength, and agility. I would drop all this mileage and do some sprinting at least several times a week. I would work harder on strength training for th

Okay, so after 4.5 years, 2 knee surgeries, and 1000+ hours of physical therapy, I've been able to get back to ultramarathoning. What exercises, strategies, and approaches seemed to work for me and what didn't seem to help? I'll explore that below. So, what worked? Start from where you are. Progress rehab and training very, very gradually. Patience.  The general approach that ultimately helped me return to ultramarathon form was the same one that enabled to me to become successful at the sport in the first place: play the long game and sneak up on amazing a little at a time. To return to running, what I needed to do first was to re-learn how to walk. Once I could walk for 5 minutes without my knee swelling so much that I couldn't walk again for several days...I had the foothold I needed to get started. It is important when you are starting a training program to begin from where you are. The first several weeks should be boringly easy. You need to not only start with som

  I'm back! Yes, I did make it back to ultrarunning! I ran 45 miles in 7:43:29 at the Frosty Looper 8-hour race in Pennsauken NJ last Sunday. That was good enough for 17th place out of 120 finishers. To all who have supported me, encouraged me, treated me, and/or rehabbed me...THANKS! After 4.5 years, 2 knee surgeries, and over 1000 hours of physical therapy and rehab, I was able to get out there again...and not just to start and "give it a go"...but to run well and finish strong. The Race.  The race started at 8 AM on Sunday morning. It was in the low 50s and windy for most of the race with occasional drizzle. In the last hour it started raining a bit more steadily...but overall the conditions were better than could be expected for mid-December in NJ. My plan was to run 10:something minutes/mile for as long as I could. I knew I could hold that pace for 22 miles since I did it in my last long run. I also knew that I could probably go much further at that pace since my hea

Just a brief update here...the long runs I've done for the past 3 weeks have covered 19, 22, and (today) 15 miles. I'm tapering a bit and hoping to toe the line for an 8-hour timed race in 2 weeks. My peak weak covered 46 miles total. I've continued with the 1-minute fast/1-minute slow intervals over the last 3 weeks with top speeds under 6:30/mile. I'm far less trained than I've been for any ultramarathon (and less trained than for all but one of my marathons), but I think I have the fitness to give it a try and hope for a middle-of-the-pack or better finish. I'm shooting to cover over 40 miles. I still have some doubts about making it to the start line. My surgically repaired right knee is aching a bit. In addition my left knee has become sore. It's a bit stressful at work right now (and preparing for the holidays) and there are lots of "bugs" going around. If I can get through these two weeks and get to the line...that would be quite a triumph.

The tweaks I have made to my training since my last setback have paid off. By keeping my long runs slower, I have been able to go as far as 16.5 miles in a single run (at about 10:30/mile pace) and 37 miles in a 7-day cycle. I'm happy that I've been able to go much farther this year.  It's not out of the question that I will try to run an ultramarathon by the end of the year. Everything would have to go well over the next several weeks for that to be possible. If things don't go well...I'll back off and start thinking about maybe doing a long race in the Spring.  My plans for the next few weeks include doing some speedwork (as I've been doing...see below) and trying to move my long run to 18 and then 20 miles. If it is just not there...I'll back down. The race I'm thinking of doing is a timed race in mid December. If the next few weeks go well, I'll follow up with more on the length of the race and how I will approach it. My knee is still a little bi

For a 2nd time I've had a knee pain flare and now I've begun mileage building for comeback attempt #3. Obviously I went too far and/or too fast (I'm leaning towards "and" being the culprit here). I'm now back up to a 9-mile long run (and a 25-mile week) and I'm taking care to slow down my long runs this time. On the previous two failed build-ups (both times failing after 11.5-mile long runs/31-mile weeks), my longest runs were also my fastest (with many sub-10-min/mile splits and a few sub-9:30-min/mile splits). I'm going to try separating the speed and endurance elements a bit more and put a strict speed limit on my long runs...no more sub-10-min/mile splits. I haven't restarted any kind of speed or quality work yet, but I'll embed speedwork in my medium run once per week starting pretty soon (if everything goes okay). I think it this comeback falls short again, I might need to try something very different. I'm thinking that I'll take

The running has continued moving in the right direction since my last update. I'm consistently running 5 days per week. I just completed my first 30-mile week of the year and also my longest run (11 miles). I'm on a streak of 20 miles or more per week for 19 consecutive weeks. I have recently gone to a pattern of two "hard" weeks followed by one rest week.  I did 13 "strider" workouts (really 30-second intervals) over 11 weeks and worked some of the repeats to faster than 6 min/mile (10 mph) pace. My peak paces on some of those repeats were around 5 min/mile. I don't have blazing sprint speed (by any stretch of the imagination), but I'm quite pleased with the improvement in my stride at faster speeds. Now I've just started a new training phase with a focus on hill work (and some additional work on speed as well...some longer "R" repeats to use Jack Daniels' terminology). This is in preparation for future training...I like to do maxV

I haven't done an update in a while...because there has been little to update. I have not had a significant setback since that Feb 19th update. I have also not really had a great leap forward. I've been running a consistent 5 days per week and have been inching my mileage and speed upward. I have run at least 20 miles per week, every week, for 13 consecutive weeks. My biggest mileage week is the one I just completed: 25 miles (so, on average I've been raising my weekly mileage by about 0.3 miles per week).  My mileage increases have been so small and gradual, I don't think my body notices the difference from week to week. However, cumulatively...I'm getting somewhere. My weekly long run is up to 9 miles. I averaged 9:55/mile on this morning's long run. My fastest miles have typically been around 9:30/mile and I've gone a bit faster a few times.  The most significant change in my training is adding some 30-second repeats (with 90-second rest intervals) to one

Well...that last setback turned out to be a big one. My tender right knee has prevented me from running as long or fast as I was running in October of last year. I just had my best week since that setback: covering 19 miles in 5 runs with a longest run of 5.5 miles. In October I had a long run of 11.5 miles and was able to go 9.9 mph (6:04/mile) for up to 30 seconds on the treadmill. It has taken me these past 3 months to gradually get back to being able to run around 11:00/mile or so at my fastest. Much was lost...but since the start of 2023 I've been slowly and gradually progressing in distance and speed. I did not handle that last setback well (...and in fact I'm still not handling it optimally). I should have went back to the orthopedist. However, with the holidays approaching, the thought of more orthopedist visits to NYC and MRIs and such was totally unappealing...so I procrastinated. I have a rheumatologic condition that could very well have caused or contributed to my k

On Sunday Oct 23, I had my longest run post surgery. 11.5 miles. I averaged 9:37/mile and by the end was running around 9:20/mile. Definitely the best long run post surgeries. After taking the next day off, I decided to do my "tread striders" workout on Tuesday Oct 25. Though my knee felt a little sore and stiff, I did 18 30-second striders with the last six at 9.9 mph (6:03/mile). That is the fastest I've been able to do this workout. However, this was clearly a bit too much. In the days that followed I had a major flair up of pain and stiffness in the right knee. I think there was a bit of swelling as well.  After the knee pain flare up I took 3 days off of running and then tried to resume. That didn't go so well. Running has been painful. I missed some weight lifting workouts as well. My knee has felt a little better the last 3 days and I've been able to do two short and easy runs and a weight lifting session. Hopefully I'm on my way back from this setback.

Today I finished my longest training run so far (10 miles) and my first 5-day training week. This ends a particularly productive 3-week period of training, where I was able to execute all my planned workouts.  The "tread striders" workout I've described before (30 seconds of increased speed with 1:30 jog rest intervals) has been paying off. The first time I did that workout a few months ago I topped out at 7 mph. During my last tread striders workout, I did the last 6 repeats at 9 mph (6:40/mile). My form is holding up. Looking at my data on Garmin Connect, I can see that my stride actually looks much better in terms of left/right balance when I'm running faster (green and yellow points on graph below). I'm still spending much more time on my left (uninjured) leg when I run slowly (red points on the graph). I'm thinking of running a half-marathon in December. I was going to ditch the tread striders temporarily and try to do some maxVO2 running (with the help o

Since my last entry here, I have made some good progress in my comeback from two knee surgeries. I've continued to run 4 days per week with a long run (that reached 8.1 miles on Aug 7) and a workout of "tread striders" where I was able to finish with 5 x 30-second repeats at 6:59/mile pace. Nice milestones for sure, but I just returned to running today after missing 8 days in a row with Covid. I feel like trying to overcome the knee injury and knee surgeries is already an extraordinary challenge. It seems unfair that I also have to deal with things like illness, running injuries, work, a poor night's sleep, etc. But it's true. I'm subject to all the same issues any other runner has to deal with...maybe even more since I haven't run much in a few years, I have a surgically repaired right knee, I'm 57 years old, and I have a more-than-full-time job and family responsibilities. It's kind of like the movie Inception , but instead of a dream within a

I am now over a year out from my 2nd right knee surgery and 19 months out from cartilage surgery. After experiencing a setback about 7 weeks ago, I took a few extra days off from running and reduced or eliminated exercises other than walking, running, and strength training. I slowed my pace during runs and stopped doing the "tread hills" incline workout I had been working on for several months. This has worked well. I've bounced back nicely over the last 6 weeks. For the past couple of weeks I've been running 4 days per week (vs. the every-other-day schedule I had been following). My pattern looks like this: Mon: strength training (w/ BFR) Tue: easy run (4 to 4.5 miles) Wed: off Thur: tread striders (4 to 4.5 miles w/ 12 x 30-second striders getting progressively faster. 1:30 jog intervals) Fri: strength training Sat: short easy run (2 to 3 miles) Sun: long run (6.5 to 7 miles) The distances approximate what I'm doing now. Of course I'll gradually add distance

One week ago, I woke up with increased pain on the medial side of my right knee. It was painful to walk. I took the next 2 days off from running and dropped the strength training and physical therapy exercises. I have been able to start running again, but I've had to slow my pace down significantly to keep the pain to a minimum. I've abandoned the idea (for now) of continuing hill work and/or starting some faster striders on the treadmill. I'll run every other day for a while and I'll try to keep it slow. I will reintroduce strength training as soon as tomorrow and then gradually add back in other exercises. I may ditch the indoor cycling for a while. So...how did this happen? I really don't know. There was no obvious misstep that started the increase in pain. The day before I woke up with this pain I had a relatively easy day of exercise. No running. No strength training. I did some easy cycling, but maybe pushed it a shade harder than recent efforts. I did some ph

It's been over 17 months since my first surgery (rt. knee mosaicplasty and OATS) and nearly 11 months after the second surgery (partial synovectomy/patellar release/fat pad resection). I'm still improving (albeit very slowly). I'm still following an every-other-day pattern of running with a 6-day cycle that includes a treadmill "hill" workout, a long run, and an additional easy run. My longest run so far has been 5 miles (which took me 48 minutes to run). On my fastest days I'm able to sustain around 9:15/mile for a while...but most of the time I'm running between 9:30/mile and 10:30/mile. I can do 5 3-minute repeats of 8% incline on the treadmill at about 10:15 pace with 2-minute rest intervals of easy running. My stride has improved a little bit, but I still have much work to restore my stride. The incline work on the treadmill has helped, but within the next several weeks I'll start doing shorter and faster intervals rebuild my stride. Well...at lea

Earlier this week I was able to run for 40 minutes, covering a little over 4 miles. Definitely a nice milestone for me. Overall, my progress has been very slow, but steady. I'm still running every other day. Making sure I am recovering well has helped me to progress. In fact, I've almost completely stopped cycling, which I had been doing every day while recovering from my two surgeries. As the running load has gone up I needed to find a way to reduce the overall load on my knee. A few times I started to get some burning pain in the knee, but that has been absent since I dropped the cycling a few weeks back. I've restarted BFR training to strengthen my right leg, but I'm only doing that once every 4 days. The lack of exercise on non-running days is making it harder to keep my weight within reason, but eventually increased running (and possibly a return to some cycling) will make that easier down the line. I've been doing a treadmill incline "hill" workout e

Over the past month, I've worked my way up from 20-minute runs every other day, to a 30-minute run (earlier today). I briefly plateaued at 20 minutes, then worked my way (1 minute at a time) to 25 minutes. I plateaued briefly at 25 minutes, then progressed (again, 1 minute at a time) to 30 minutes. As my runs increased in duration, my pace slowed a bit (to an average of 10:30/mile or so), but today I ran just a shade slower than 10 min/mile pace, so perhaps I am adapting to the increased load. After not running since August 2020 and going through knee surgeries in Dec 2020 and June 2021, it feels absolutely amazing to be out there running for a half hour again! I'm still feeling pain, but that has not really increased since I started running 15 seconds at a time last November. I'm concerned about the pain, but I'm going to stick to my plan, which seems to be working. So, what's next? In my last blog post I wrote, "As soon as I feel adapted to running for 20 min

 ...well...at least for now. During my last 2 every-other-day walking/running workouts, I was able to run for 20 minutes continuously. This achieves an intermediate goal. Hopefully this is a stepping stone to further achievement. My pace has been pretty good for this stage. (Maybe too good?) I was able to average exactly 10 minutes/mile pace and cover 2 miles today. I have been having some right knee pain during these runs (although my knee felt better today than during the last run). Also there has been some pain and swelling after the runs...this started with the last interval workout I did (4 x 4:45/19 minutes of running total) before starting continuous running.  Things had gone reasonably smoothly as I worked my way from 1 minute of running to 18 minutes of running over several months. I was recovering well and always ready for the next walk/run. With the increase in pain and swelling, it is clear I need to "plateau" here for a while. I need to make sure I can recover fr

I'm 6 months out from synovectomy/patella release/fat pad re-sectioning and 12.5 months out from mosaicplasty and OATS surgery. I'm still a long way from a full return to running...but it has been a month of good progress. My plan to gradually convert my 20-minute walks to 20-minute runs has continued without interruption. I walk/run every other day and I've been extending my 4 running intervals by 15 seconds (each) every other workout. As of last post I was up to 4 x 45s jogs (3 minutes of running) and I'm now up to 4 x 2:30 jogs (10 minutes of running). I'm experiencing some medial knee pain...but it is not worsening as I run longer (and a bit faster) and seems to have lessened a bit during the last 2 workouts. I had a slight increase in burning pain a few weeks back, but I cut back on cycling and that has reduced symptoms. I've added a short walking interval to warm up and another to cool down after each 20-minute walk/run workout. My workouts are lasting ove

I'm 5 months out from surgery #2 and 11.5 months out from the original right knee mosaicplasty surgery. I'm still a long way from "normal", but I've started doing some "running" again. Several weeks ago, I was reintroduced to "running" on an Alter G treadmill at the place where I do my PT. I ran for 2 minutes twice (with a 3-min walk in between) at 60% of my bodyweight. Felt very strange...like I had never run before in my life. At my most recent PT visit, I did the same workout at 70% bodyweight. It went much better. I went from 14 minutes/mile pace to 12 minutes/mile. As previously mentioned, my plan was to work my way up to 20+ minutes of walking every other day and then to start adding some short running intervals to the walks. That plan has worked so far. I've done 5 walks now that included a little bit of running. I started with 4 15-second running intervals for a total of 1 minute of running and in my last walk/run I was able to do 4

Things have continued to trend better. That is not to say it has all been easy...I have days with some pain and varying levels of stiffness. However, I have continued to walk every other day. This has gone on for 8 weeks now. I started with 5 min walks (at a pace between 25 and 30 minutes per mile) and am now walking 17 minutes (at around 18-19 minutes per mile pace). I had intended to start walking more frequently, but since this every-other-day pattern is working so well for me, I just decided to ride it as long as I continue to make progress. I never extend my walking session time (from the previous session) by more than a minute. I also repeat every session time at least once before increasing another minute. I don't push the pace at all...I just relax, try to walk without a limp, and let the pace come to me. Slow, steady, and gradual...seems to be getting it done for me. My plan, as I briefly described in my last post, is to work my way up to 20 minutes of walking (comfortably

It's been a while since I posted here, so I'm do for an update. I'm a little over 3 months out from the second surgery (synovectomy/patellar release/chondroplasty/fat pad resection) and almost 10 months out from my first knee surgery (mosaicplasty/meniscectomy). I'm still in full rehab mode and have a lot more work to do. I'm still not real close to running, but I have made some progress. My right knee assisted ROM is 100% and my kneecap is moving much better than pre-surgery. My walking is far from perfect, but I've been walking outside every other day for 10 minutes. I still have sporadic swelling, considerable stiffness, and occasional pain in the knee, but I've been able to start some strength work. Hopefully activities like climbing stairs, driving, and returning to work are in the near future for me.  Today I started doing blood-flow-restricted (BFR) training at home. I purchased wireless Bluetooth BFR cuffs that I can calibrate and inflate with a phon

Well, here I am again. Taking the same meds, doing the same PT, and dealing with swelling, icing, and wound care just as I did for the earlier surgery less than 7 months ago. This was a bit too soon for me, but delaying this would have delayed getting past all this...and I'm not getting any younger. I am recovering much quicker from this surgery, which is not a surprise. This was an arthroscopic procedure, not the open surgery I had last time. Today is post-surgery day 13 and its the first day with no crutch usage. I removed one of the two circular bandages covering the surgical "portals". It stuck a bit and caused some bleeding around the stitches (so I put off pulling off the 2nd bandage...maybe tonight or tomorrow). I'm taking meloxicam for the first 30 days post surgery and have not required medication for breakthrough pain (other than acetaminophen a few times). No nausea. No itching. My PT seems to be going well. I'm going in to NYC this time and other than

I'm one day post surgery now. It seemed to go well. Since this was an arthroscopic procedure I had a lot less bleeding and swelling this time and was able to restart PT exercises this morning. The orthopedic surgeon (OS) seemed to be pretty positive on how it went. He said he removed a substantial amount of inflamed tissue. He also said the osteochondral grafts (from the last surgery) look great. Kneecap mobility should be improved (and seems to be…although I didn’t push on it too hard today since I have a couple of holes right under my kneecap). The OS also did the patellar release, resected the scarred fat pad, and did some smoothing of patellar and trochlear cartilage. I used 2 crutches to get around yesterday after the surgery, but I've already weened myself to a single crutch. Looks like I'll be back to crutch-free walking this week. I also should be able to return to weightlifting later this week as well. Hopefully I'll be able to resume my recovery path back to r

After visiting my orthopedic surgeon (OS), I have agreed to his recommendation to have another procedure. There are several goals of the procedure…including removing inflamed synovial tissue, cleaning up adhesions, and releasing my kneecap (which lacks mobility even though I have been working on that for months during physical therapy). He is confident that this will point me in the right direction. As I expressed in my previous post, I’m wary about having another surgery to fix the first surgery. I was very overreactive to the first surgery…won’t I be for the second one? Well, I think this approach has its risks, but I’ve not made much progress for 6 months, so it is time for a change. The procedure will be an arthroscopic surgery that should take only 20 minutes or so. I’m scheduled to do this on June 28. I am so not looking forward to being on crutches, medications, and a cryotherapy machine, but I’m going to have to grind it out. I am going to go into NYC once a week and work with